• Wei Hu, Jiang Zhou, Zheng-Min Liu, Ye Li, Qing-Feng Cai, Xiao-Ming Hu, and Yan-Bing Yu.
• Department of Neurosurgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou 317000, China.
• Int. J. Clin. Pract. 2023 Jan 1; 2023: 54079125407912.

BackgroundDue to a lack of accessibility and individual differences in surgical procedures, many previous studies on keyholes are not practical.ObjectiveTo study the surface landmarks for optimal keyhole placement in the retrosigmoid approach.MethodsThe three-dimensional (3D) skull images of 79 patients were reconstructed using workstations, with a total of 149 hemiskull base 3D images then analyzed. Skull-surface landmarks were marked, the lateral-skull surface was observed, and the positional relationships between the asterion and the extension line of the posterior margin of the mastoid process were measured. The position of the superior curvature of the sigmoid sinus groove was located before it was projected onto the lateral surface of the skull and defined as the keypoint. The positional relationship between the keypoint and the skull-surface landmarks was observed in an established coordinate system using spatial proportion relationships.ResultsThe asterion was located around the extension line of the posterior margin of the mastoid process, and the vertical distance from the extension line was <15 mm. It was found that 93.29% (139/149) of the keypoints were located in a 7 mm radius circle, with the center at (-0.41, -3.01) in the coordinate system in the 3D computed tomography images.ConclusionWhen using this method, the spatial proportion relationship of the anatomical marks can accurately locate keyholes, therefore providing technical support when employing the retrosigmoid approach.Copyright © 2023 Wei Hu et al.

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